Want to see the healthcare rates for my mom, who is 55 years old and works 2 jobs?

[Ms. Toad]

72. There are no limits on doctor's visits on ANY of the plans.

Last edited Tue Oct 1, 2013, 04:45 PM - Edit history (1)

But this structure is a modified high deductible plan - which is not really intended to cover day-to-day medical expenses. In traditional high deductible plans you pay 100% for everything until you reach the deductible, then the co-pays kick in until you hit the out of pocket maximum (and often they are merged; my current plan has a $6000 deductible and a $6000 out of pocket max - I pay 100% of everything until I hit $6000, then I pay nothing).

In order to make sure you visit the doctor when needed, the plan exempts some visits entirely from the deductible (the preventative care ones) and allows you to visit the doctor a few times at a lower out of pocket cost even before you meet the higher deductible, and at least one time without charge.

The normal structure for that kind plan (generally referred to as catastrophic coverage), though, is you pay 100% of everything until you reach the deductible. As modified in the exchanges (or at least the CA one), you are entitled to at least 3 visits even though you have not met your deductible for $60 each, plus the preventative. Beyond that additional visits either have a $0 co-pay or it reverts to catastrophic coverage (you pay everything until you hit the annual cap, then you pay nothing - I haven't found enough detail to know which).

It is not a plan for everyone - but it is better than my current coverage and the coverage which I purchased when I was not eligible for any other coverage because of pre-existing conditions. Younger individuals, who are healthy and just want to make sure they are not completely wiped out by a catastrophe might find this cheap plan attractive because they generally have low premiums in exchange for accepting more of the risk. If you expect to need more than 4 visits (preventative + 3), you might want to confirm who pays for the 4th visit if you have not had a medical catastrophe - or look at a more traditional plan.

It is explained slightly differently here:

http://www.medicoverage.com/health-insurance-blog/news/comparing-exchange-plans-bronze-silver-gold-platinum

What is listed in the chart is what you pay. It looks to me as if you pay $60 for each of the first three visits. There is no additional payment listed for the 4th - Nth visit - so it looks to me as if there are no additional charges for those. But, as I said, it isn't entirely clear.